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The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS) (2005)

Discussion in 'Latest ME/CFS Research' started by Dolphin, Sep 24, 2013.

  1. Dolphin

    Dolphin Senior Member

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    I read this yesterday. It reminded me of some of the frustrating things about Peter White's views - useful to motivate me to challenge him and people who have adopted graded exercise therapy.




    Read More: http://informahealthcare.com/doi/abs/10.1080/09638230500136308
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  2. Dolphin

    Dolphin Senior Member

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    From the Introduction:

    So no biological reasons for it? Apart from vague phrases like interoception, biological reasons (apart from deconditioning) are ignored in this paper.
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  3. Dolphin

    Dolphin Senior Member

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    I am not familiar with a lot of these references. But from what I recall from the references about hypocortisolaemia

    these were simply speculative papers i.e. they didn't show deconditioning brought about hypocoritisolaemia.
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  4. Dolphin

    Dolphin Senior Member

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    This is about as biological as it gets.

    However, it ignores all sorts of other biological evidence.

    It then starts talking about "effort syndromes"

    "improvements in the perception of effort"
    is not the same as
    "reversing the enhanced perception of effort"

    It is plausible that some people with CFS are not as fit as they could be and that could partly explain different perceptions of effort between healthy people and people with CFS. It is quite another to claim this fully explains this.
  5. Dolphin

    Dolphin Senior Member

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    Model underlying GET:

    This ignores the fact that all the symptoms can't be explained by deconditioning e.g. alcohol intolerance (otherwise there would be far fewer problem drinkers around).

    It also ignores how people can suddenly be experiencing extra symptoms after relapses, without being more deconditioned, etc.
  6. Dolphin

    Dolphin Senior Member

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    Lots of people went around undiagnosed for many years, unaware that they had CFS, so not convinced of this model.

    In my own case, I was ill over five years before being diagnosed. When I initially became ill, I was 16 and in full-time education. Notes from the time suggest I missed two days of school. After that I was always on my feet. The bus stop was nearly a mile from our school (and in college it was further). People in our house never went to bed if ill and neither did I. About the longest I was relatively inactive was around two days within the house.


    GET is not about listening to one's body.

    Another example of this:
    No talk about the body not adapting.
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  7. Dolphin

    Dolphin Senior Member

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    Note that this is making a distinction between the aetiology (initial cause of the illness) and the pathophysiology (ongoing causes). As the subsequent sentence shows, it is based on some assumptions/it is based on a model of pathophysiology/what is perpetuating the condition.

    Note the use of the term recovery - their model suggests GET should be able to bring about recovery.
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  8. Dolphin

    Dolphin Senior Member

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    The paper goes on to review the GET studies that have been published:

    On Wearden et al (1998) it says:
    I'm not sure I noticed the latter statistic being mentioned before. The authors themselves don't in the text, just in a figure (which has other info too):

    33 randomised to graded exercise and fluoxetine --> 9 complied fully with graded exercise

    34 randomised to graded exercise and drug placebo --> 14 complied fully with graded exercise

    So only 23 out of 67 (34%) were said to fully comply with graded exercise

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  9. Dolphin

    Dolphin Senior Member

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    The Action for ME 2003 survey, which has a small sample size anyway, doesn't have quantitative data that shows that at all. The report was written by Chris Clark who was in some ways close to Peter White e.g. wrote a letter supporting the application for MRC fuding for the PACE Trial; it is possible he asked for PDW's input for the report or was conscious of PDW's views when writing it. It is frustrating when Peter White keeps claiming this when the evidence isn't there. I've attached the file to let people read for themselves.
    I haven't looked at it in a while - I think this is the relevant table:
    [​IMG]

    What the Edmonds et al. (2004) study showed that on average fatigue scores and the like were improved. That doesn't show that for some people, GET couldn't make them worse.

    This paper discusses such issues in a lot more depth:
    Reminder: in the abstract they said:
    But the studies at that stage didn't give such information.

    They also made a statement about harms in their summary:

    Attached Files:

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  10. Dolphin

    Dolphin Senior Member

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    It's useful to have the data summarised like this.

    All sorts of quack therapies could also get many of these results. (There were improvements in physical fitness in Fulcher and White (1997) but the level of improvements don't seem to have been replicated in White et al. (2011)).
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  11. Dolphin

    Dolphin Senior Member

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    There is no mention that increased adherence might increase chances of adverse reactions.
    ---

    That's about it for me on this paper. I haven't tried to do an indepth critique with lots of counterexamples so I'm sure others can add more.
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  12. Esther12

    Esther12 Senior Member

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    Thanks for those notes D.

    So it was when there was no professional guidance that patients were least likely to report harm?

    As you say though, it's a very small sample.
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  13. Dolphin

    Dolphin Senior Member

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  14. Simon

    Simon

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    Yes, the sudden increase in symptoms after a relapse is a spectacular hole in the deconditioning theory, yet the proponents of it have never even addressed the 'relapse problem'.

    Another problem is that when healthy people become severely deconditioned by space travel, or voluntarily in bed rest studies, they don't suffer with anything like the level of fatigue seen in CFS - even though they are more deconditioned than CFS (out)patients.
  15. user9876

    user9876 Senior Member

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    I particularly liked their method description

    Translating the non-systematic as cherry picking of quotes from papers that could be twisted to say what they want.
  16. Simon

    Simon

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    Agreed. Their point is wrong, and I think this is worth addressing as a similar line is used by Simon Wessely too when he talks about biologial 'causes' of the illness.

    The key point is that CFS requires a minimum of 6 months of fatigue to be diagnosed. So the argument that people get sick or have some physical trauma and that is the cause of the illness is fallacious: most people recover in such situations. The 'cause' of CFS in such cases is what causes CFS to develop following on from those initial triggers shared by many.

    The glandular fever model of CFS is a perfect example of this. Everyone gets fatigue as part of the illness and for some time afterwards - the question in this model is why do some people go on to develop CFS? According to Rona Moss-Morris, it's patients flawed beliefs and behaviours. The Dubbo study (which also looked at psychlogical factors) concluded that biological factors were central.

    Note that people who get fatigue as part of the illness but don't develop CFS are in the majority - the 'trigger' for them did not trigger CFS. So whatever else is involved is a critical part of the aetiology of the illness. Therefore the perpetuating cycle of fatigue and disability that Clark and White hypothesise IS part of the aetiology of CFS, despite the hand-waving claims to the contrary.
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  17. Sean

    Sean Senior Member

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    Non-systematic reviews should simply be never be published. Shame on the journal editors for publishing it.

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